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Paul Zimmerman

Showing 8 posts from January 2016.

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radiantskies ©

FTC Sues DeVry University for Deceptive Advertising

On January 27, 2016, the FTC filed suit against DeVry University in the Central District of California, alleging that the school deceived consumers about the success rates of graduates from its programs. According to the Complaint, more than 870,000 students have enrolled in DeVry since 1975, attending classes at more than 50 campuses throughout the country. DeVry’s total gross revenues between 2008 and mid-2015 exceeded $14.5 billion, with DeVry spending more than $135 million annually on advertising. That advertising, the FTC contends, included false and unsubstantiated claims intended to draw in new students. (Read more)

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Alexander Raths ©

Health Net And Other Payers Ramp Up Audits Against Addiction Treatment Providers

Over the past several months, we have seen a tremendous amount of payer attention directed at addiction treatment providers. Payers are sending increasing numbers of requests seeking a range of medical records, billing records and other documentation concerning the provision of substance abuse treatment and related services, with several major payers seeming to aggressively investigate providers’ claims. Payer requests range from commonplace medical record requests, on the one hand, to requests for information about patient residency and co-payment obligations on the other, and have included requests for facility licenses, state and county certifications, and CLIA certificates. (Read more)

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Dmytro Zinkevych ©

When the Exception Swallows the Rule

When I was in law school, one of my professors used a metaphor to make a point. In law, there are rules and exceptions to those rules, and sometimes the exceptions become so large that they “swallow” the rule. Instead of referring to it this way, however, my professor would call this situation “The Tomato That Ate Cleveland,” referencing a 1950s sci-fi movie. (Read More)

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convisum ©

National Association of Registered Agents and Brokers Gets its First Board Nominees

On January 12, 2016, as part of H.R.26 (the Terrorism Risk Insurance Program Reauthorization Act of 2015), legislation authorizing the formation of the National Association of Registered Agents and Brokers (NARAB) became law. The legislation authorized the formation of NARAB, and the implementation is now underway. (Read more)

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Bakhtiar Zein ©

Can States Require Access to Health Care Data?

Last month, the United States Supreme Court appeared skeptical that states have the authority to require self-insured plans to supply large quantities of data regarding how much they pay for their medical claims. The case, Gobeille v. Liberty Mutual, concerns efforts by Vermont and other states to enforce an all-payer claims database, requiring insurance companies (including self-insured plans), to collect and publicize the data in a statewide database. (Read more)

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Ivelin Radkov ©

California Considers Revision of Public Insurance Adjuster Law

UPDATE:  SB 488 was passed by the Senate Insurance Committee on January 1, 2016, by a vote of 8-0.  Although the bill received no negative votes, witnesses expressed some concerns. Certain Senators who supported the bill requested, and received, the author’s commitment to continue working to address these concerns. It appears likely that SB 488 will be passed by the Senate in its current form, but that it will be further amended in the Assembly.  

Legislation which would significantly revise California law relating to public insurance adjusters is under consideration in the California Senate. The bill, SB 488, is authored by Senator Marty Block of San Diego. The bill was originally introduced in early 2015, but it was not heard in the Legislature last year.  (Read more)

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Milosh Kojadinovich ©

Are Robot-Operated “Smart Restaurants” the Wave of the Future?

In the face of increasing minimum wage laws and shrinking numbers of qualified cooks in the work force, many restaurants are feeling the heat. One Bay area start-up, Momentum Machines (Momentum), is touting a solution that may alleviate these business pressures.  Momentum is banking on the idea that by having machines replace line cooks in the kitchen, a restaurant can obviate the need for a work force entirely. (Read more)

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zimmytws ©

Medicare Data Not Indicative of Overall Healthcare Spending Costs

In December 2015, a  research team at Carnegie Mellon published a paper titled “Examining the Variation in Health Spending and in Hospitals’ Transaction Prices” after receiving access to insurance claims data from Aetna, Humana, and United. (Read more)